The Comparison of Iranian Normative Reference Data with Five Countries ‎Across Variables in Eight Rorschach Comprehensive System (CS) Clusters.

Objective: This study aimed to provide a normative study documenting how 114 five-seven year-old non-‎patient Iranian children respond to the Rorschach test. We compared this especial sample to ‎international normative reference values for the Comprehensive System (CS).‎ Method: One hundred fourteen 5- 7- year-old non-patient Iranian children were recruited from public ‎schools. Using five child and adolescent samples from five countries, we compared Iranian ‎Normative Reference Data- based on reference means and standard deviations for each sample.‎ Results: Findings revealed that how the scores in each sample were distributed and how the samples were ‎compared across variables in eight Rorschach Comprehensive System (CS) clusters. We reported ‎all descriptive statistics such as reference mean and standard deviation for all variables.‎ Conclusion: Iranian clinicians could rely on country specific or "local norms" when assessing children. We ‎discourage Iranian clinicians to use many CS scores to make nomothetic, score-based inferences ‎about psychopathology in children and adolescents.‎.


Rorschach (1) Comprehensive System method (CS; 2)
is crucial to its use in clinical practice. As with other tests, Rorschach interpretation rests on (a) quantitative, nomothetic normative comparisons, and (b) qualitative idiographic, individualized inferences. Thus, evaluating deviations from normative expectations is a central component in quantitative interpretation. However, the adequacy of the CS adult and child reference values (2) has been discussed and debated in the literature over the past decade, both with respect to samples from the U.S. (e.g., 3; 4; 5) and other countries (e.g., 6; 7; 8; 9; 10). The available CS norms for children and adolescents were first published in 1982 (11). At the time, the authors questioned how representative their samples were, cautioning users that as a result of likely self-and parent-selection biases they were probably too healthy and wellfunctioning to generalize to typical participants. Therefore, it is of prime importance to identify what more recently collected samples look like when plotted on the Adult Composite International Norms.
A study that sparked concern about the standard CS reference values was Shaffer et al.'s (1999) sample of 123 adults from Fresno, California (4). These participants were tested by graduate students, that Weiner (2001) questioned as a suitable level of training and experience to serve as a reference sample (12). Nonetheless, because both the Fresno sample and the traditional CS norms were obtained from non-patients in the U.S., any disparities between them were notable. In particular, Shaffer et al. Reported many shorter and more simplistic records than the existing CS norms. For instance, their sample had a mean R = 20.8 (versus 23.5 in the CS norms) and a mean Lambda = 1.22 (vs. 0.58), with 41% of their sample classified as having an avoidant style (i.e., Lambda > 0.99; vs. 14%). Wood et al. (2001aWood et al. ( , 2001b showed that a number of non-patient samples from the literature produced notably different mean values from the CS norms (CS 600), with effect sizes ranging from small to very large. Form quality (FQ)-related (i.e., XQ%, X-%) and colorrelated variables (i.e., Afr, FC, WSumC), as well as Iranian J Psychiatry 11:3, July 2016 ijps.tums.ac.ir popular (P), whole, realistic human content (Pure H), diffuse shading (Y), and reflection (Fr, rF) responses were the most problematic variables (5). Other empirical evidence also showed that the distributions for form quality (FQ) and number of responses (R) might diverge from the CS normative expectations in non-patient samples (11). Meyer et al. (2007) presented descriptive data from 4,704 Rorschach records from non-patient samples from Argentina, Australia, Belgium, Brazil, Denmark, Finland, France, Greece, Israel, Israel, Italy, Japan, Peru, Portugal, Romania, Spain, the Netherlands, and the United States (13). The mean age of the entire, combined sample was 36.65 (SD = 11.71). Years of education, gender, and race were not reported. Analyses of these international data revealed that both the CS 450 collected by Exner and Erdberg (2005) and the CS 600 collected by  diverged from most of the other samples for a large proportion of the variables (14) (15). Applying CS 600 interpretive routines to all these samples may result in pathologized interpretation of these non-patients. Viglione and Meyer (2008) summarized the recurring main differences between the CS 600 and other samples and reported that other samples frequently produced more unusual location responses, inferior form quality, fewer elaborated, positive human representations, less color, and fewer texture responses (16). To provide the Iranian Rorschach users with more representative normative benchmarks and to reduce the risk of overly pathological interpretations, we presented an Iranian normative reference sample. In this study, we extended the previous analyses in several ways. First, we reported data collected for 5 to 7 yearold Iranian children. Second, we utilized international normative reference values for the CS for children and adolescents (2). Third, and most important, we focused on the extent to which international normative reference values for the CS correspond to Iranian sample.

Participants
The sample for this study consisted of 114 non-patient Iranian children aged 5 -7 who were recruited from public schools. Recruitment began with identifying an area of Tehran that has numerous schools and is demographically representative of its population. Within this area, 15 public schools and five kindergartens were randomly selected. The principals of the schools sent a letter to the parents in which they described the purpose of the study-to collect normative reference data on a psychological test-and asked them to sign and return the letter if they agreed to have their children participate in the study. Before sending the letters, the principals reviewed their school records and removed from the list any students who had been identified as having psychological problems. Similarly, the parents were asked not to sign and return the letter of agreement if their child had been diagnosed with or treated for any psychological disorder within the last two years or had undergone psychological testing within the past year. Approximately 90% of the parents signed the letter. Children's participation in the study was voluntary and required their consent as well as their parents' approval.

Procedures
The Rorschach data were collected by 15 examiners; all of whom were graduate students of the Allameh Tabatabaei University, who have completed an assessment course that included instruction in the administration, coding and interpretation of the Rorschach; and they were currently enrolled in a twoyear Rorschach research practicum co-mentored by the second author. All of the examinations were conducted in Farsi in the counseling rooms of the students' school, following a brief warm-up and the completion of a short semi-structured interview. The Rorschach administration was conducted according to Exner's (2003) Comprehensive System instructions, including his procedures for obtaining at least 14 responses and avoiding excessively long protocols (2).

Samples and Procedures for Comparison
In 2007, a supplemental issue of the Journal of Personality Assessment was devoted to international normative data for Rorschach Comprehensive System. In this special issue, a number of investigators collected 39 samples from 17 countries (18). These international reference data included samples of children and adolescents from Denmark (19), Italy (20), Japan (21) Portugal (22) and United States (CS; 2). Subsequent publications have presented Rorschach reference data on samples of non-patient children in Brazil (23) and adolescents in Israel (24). The samples differed in their quality (e.g., examiner training, scoring reliability, and checks on administration quality); however, motivated and trained individuals seeking to advance the database of Rorschach assessment collected all the data.

Table2 (Continue). Rorschach Variable Frequencies for 114 Non-patient Iranian Children and Four Country
For instance, Table 1 shows that R has M = 21.60 and SD = 5.33. Reference mean and standard deviation allow one to determine quickly how far a person or a sample is from the expected norms and to see how typical or atypical values are for the person or sample compared to the norms.  Table 1 (i.e., Styles, D-Scores, Form Quality, S-Constellation Positive and so on). Table 2 shows how the scores are distributed within each country. Given that positive and negative deviations from the mean cancel out, the most salient information in this table is the dispersion of scores.

Discussion
Based on the seven clusters proposed by Exner (2), we briefly present the key data concerning normative findings to emphasize how Iranian children respond to the Rorschach:

Information Processing
As displayed in Table 2

Controls and Stress Tolerance
According to the high lambda, there was an exception that median of other determents were low. This was also noticeable in FM and also C, shading response and T. In fact, the mean of C was equal to 2.96 in the 5-7 year-old sample (in comparative

Affect
Iranian children provided a small number of responses with color determinants, and this may be due to the high Lambda values cutting through other samples. Inspection of the Afr value gave rise to a new fact when explaining the reason for this decrease. Afr mean values was 0.49 in the Iranian children aged 5 -7. The last point warranting our attention was the fact that CF mean values were always lower than FC ones, with the exception for the 5-7-year-old group, whose values were 0.56 and 1.08, respectively.

Self-perception
The

Interpersonal Perception
Two or three aspects should be emphasized considering some of the variables.

Limitations
The results of this study should be interpreted with caution. These reference data were collected in the city of Tehran and might not generalize to a nonurban population.

Conclusion
Considering the goal of identifying normative reference values that transcend countries, cultures, languages, recruitment strategies, types of normative target populations, examiner training, and age, the data contained in this study present small different values for the CS in each of the mentioned countries. Although the findings in Meyer, Erdberg & Mihura Supplement (2007), strengthen our ability to use an international normative reference standard for the Rorschach with adults, the data in this study challenge our ability to do so for children and adolescents (25). In agreement with the notation of Meyer and Viglione (2008) that indicated child reference data are unstable, and cautioned clinicians about making inferences on the topic of psychopathology in children from CS data and given the findings of this study, we take this caution further (16). We do not understand the cultural, societal, examiner, and/or administration and scoring factors that are responsible for the erratic results seen with children and adolescents. Finally, it may seem that clinicians could rely on country specific or "local norms" when assessing children. The findings in this study and Meyer, Erdberg & Mihura (2007) leave us concerned that normative information collected by one group in a particular locale may not generalize to the types of data obtained by all clinicians working in that locale (25).
AG: Special Score for coding the use of movement that is aggressive in nature ALOG: Autistic Logic, Special Score for coding the use of strained reasoning An: Content code for reference to internal anatomical concepts An+Xy: Content code for reference to anatomical concepts and X-ray (Xy) Art: Content code for reference to artistic concepts Ay: Content code for the use of anthropological concepts of a historical or cultural nature Bl: Content code for the use of blood, whether animal or human Blends: A response that contains two or more determinants; they are separated by a period Blends/R: The number of Blends divided by R. Bt: Content code for the use of botanical concepts C: A determinant reflecting the use of only color in generating the response C': A determinant reflecting the use of only achromatic color in generating the response C'F: A determinant reflecting the emphasis of achromatic color over form in generating the response CDI Total: The total of all variables that constitute the Coping Deficit Index CF: A determinant reflecting the emphasis of color over form in generating the response Cg: Content code for the use of clothing Cl: Content code for reference to a cloud Cn: Color naming; a determinant reflecting the use of color by name as the response Cognitive Special Scores: Special Scores reflecting cognitive slippage (DV, INC, DR, FAB, ALOG, CONTAM) Col-Shd Blends: The total number of Blends combining chromatic and achromatic or shading determinants or both. CONTAM: Contamination, a Special Score reflecting the merging or blending or both of two contents within one blot area Content: The category in which the response is located COP: Cooperative Movement, a Special Score reflecting the use of movement (M, FM and m) that is positive or collaborative CP: Color Projection, a Special Score reflecting the attribution of color to an achromatic portion of the blot D: Location code indicating a response involving a major detail, one identified in the Card's location table D Score: Calculated by EAes Dd: Location code indicating response uses an unusual part of the blot, one that may be identified in the Card's location table Determinant: A code that reflects how the stimulus field was translated Developmental Quality: A code reflecting the nature of processing used to produce a response DQo: A developmental quality code reflecting a single object with specific form demand DQ+: A developmental quality code reflecting a synthesized answer, one that involves two or more objects, at least one of which has form demand, that are seen in a relationship with one another DQv: A developmental quality code reflecting a single object with no specific form demand DQv/+: A developmental quality code reflecting a vaguely synthesized answer, one that involves two or more objects, neither of which has form demand, that are seen in a relationship with one another DR: Deviant Response, Level one, a Special Score reflecting the use of an inappropriate phrase or circumstantiality DR2: Deviant response, Level two, a Special Score reflecting the use of an inappropriate phrase or circumstantiality that is bizarre or outside the bounds of reality DV: Deviant Verbalization, Level one, a Special Score reflecting the use of a neologism, an individualized meaning, or redundancy DV2: Deviant Verbalization, Level two, a Special Score reflecting the use of a neologism, an individualized meaning, or redundancy EA: Experience Actual, the addition of Sum M and WSumC. Egocentricity Index: 3r+ (2)/R An index computed as 3 times the number of reflections plus pairs divided by R es: Experienced Stimulation, the sum of FM+m and SumC'+SumT+SumY+SumV Ex: Content code for reference to an explosion, including fireworks F: A determinant reflecting the use of only pure form in generating the response FABCOM: Fabulized Combination, Level one, a Special Score reflecting the use of an implausible relationship or transparency FAB2: Fabulized Combination, Level two, a Special Score reflecting the use of an impossible relationship FC: A determinant reflecting the emphasis of form over color in generating the response FC': A determinant reflecting the emphasis of form over achromatic color in generating the response FD: Form Dimension, a determinant reflecting the use of dimensionality based on the contours of the blot in generating the response